Brian D. Smedley, Adrienne Y. Stith, and Alan R. Nelson

780 Pages·2005·5.86 MB·English

by  Leona Coffee

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
http://www.nap.edu/catalog/10260.html
Brian D. Smedley, Adrienne Y. Stith, and
Alan R. Nelson, Editors
Committee on Understanding and Eliminating
Racial and Ethnic Disparities in Health Care
Board on Health Sciences Policy
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
Copyright © National Academy of Sciences. All rights reserved.
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
http://www.nap.edu/catalog/10260.html
THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, N.W. • Washington, D.C. 20001
NOTICE: The project that is the subject of this report was approved by the Governing
Board of the National Research Council, whose members are drawn from the councils
of the National Academy of Sciences, the National Academy of Engineering, and the
Institute of Medicine. The members of the committee responsible for the report were
chosen for their special competences and with regard for appropriate balance.
Support for this project was provided by the Office of Minority Health, U.S.
Department of Health and Human Services. Additional support for data collection
activities was provided by The Commonwealth Fund and the Henry J. Kaiser Family
Foundation. The views presented in this report are those of the Institute of Medicine
Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health
Care and are not necessarily those of the funding agencies.
Library of Congress Cataloging-in-Publication Data
Unequal treatment : confronting racial and ethnic disparities in health
care / Brian D. Smedley, Adrienne Y. Stith, and Alan R. Nelson, editors
; Committee on Understanding and Eliminating Racial and Ethnic
Disparities in Health Care, Board on Health Sciences Policy, Institute
of Medicine.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-309-08265-X (hardcover with CD-ROM); ISBN 0-309-08532-2 (hardcover)
1. Discrimination in medical care. 2. Health services accessibility.
3. Minorities—Medical care. 4. Race discrimination. 5.
Racism—Cross-cultural stdies. 6. Social medicine.
{DNLM: 1. Health Services Accessibility—United States. 2. Ethnic
Groups—United States. 3. Minority Groups—United States. 4. Quality
of Health Care—United States. WA 300 U515 2002] I. Smedley, Brian D.
II. Stith, Adrienne Y. III. Nelson, Alan R. (Alan Ray) IV. Institute of
Medicine (U.S.). Committee on Understanding and Eliminating Racial and
Ethnic Disparities in Health Care.
RA563.M56 U53 2002
352.1′089—dc 21
2002007492
Additional copies of this report are available for sale from the National Academies
Press, 500 Fifth Street, N.W., Box 285, Washington, D.C. 20055. Call [phone] or
[phone] (in the Washington metropolitan area); Internet, http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page at:
www.iom.edu.
Copyright 2003 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
The serpent has been a symbol of long life, healing, and knowledge among almost
all cultures and religions since the beginning of recorded history. The serpent adopted
as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now
held by the Staatliche Museen in Berlin.
Copyright © National Academy of Sciences. All rights reserved.
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
http://www.nap.edu/catalog/10260.html
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
Shaping the Future for Health
Copyright © National Academy of Sciences. All rights reserved.
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
http://www.nap.edu/catalog/10260.html
The National Academy of Sciences is a private, nonprofit, self-perpetuating
society of distinguished scholars engaged in scientific and engineering research,
dedicated to the furtherance of science and technology and to their use for the
general welfare. Upon the authority of the charter granted to it by the Congress in
1863, the Academy has a mandate that requires it to advise the federal govern-
ment on scientific and technical matters. Dr. Bruce M. Alberts is president of the
National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter
of the National Academy of Sciences, as a parallel organization of outstanding
engineers. It is autonomous in its administration and in the selection of its
members, sharing with the National Academy of Sciences the responsibility for
advising the federal government. The National Academy of Engineering also
sponsors engineering programs aimed at meeting national needs, encourages
education and research, and recognizes the superior achievements of engineers.
Dr. Wm. A. Wulf is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of
Sciences to secure the services of eminent members of appropriate professions in
the examination of policy matters pertaining to the health of the public. The
Institute acts under the responsibility given to the National Academy of Sciences
by its congressional charter to be an adviser to the federal government and, upon
its own initiative, to identify issues of medical care, research, and education.
Dr.Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of
Sciences in 1916 to associate the broad community of science and technology with
the Academy’s purposes of furthering knowledge and advising the federal govern-
ment. Functioning in accordance with general policies determined by the Academy,
the Council has become the principal operating agency of both the National
Academy of Sciences and the National Academy of Engineering in providing
services to the government, the public, and the scientific and engineering commu-
nities. The Council is administered jointly by both Academies and the Institute of
Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair,
respectively, of the National Research Council.
www.national-academies.org
Copyright © National Academy of Sciences. All rights reserved.
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
http://www.nap.edu/catalog/10260.html
COMMITTEE ON UNDERSTANDING AND ELIMINATING
RACIAL AND ETHNIC DISPARITIES IN HEALTH CARE
ALAN R. NELSON, M.D., (Chair), retired physician and current
Special Advisor to the Chief Executive Officer, American
College of Physicians–American Society of Internal Medicine,
Washington, DC
MARTHA N. HILL, Ph.D., R.N., (Co-Vice Chair), Interim Dean,
Professor and Director, Center for Nursing Research, Johns
Hopkins University School of Nursing, Baltimore, MD
RISA LAVIZZO-MOUREY, M.D., M.B.A., (Co-Vice Chair), Senior
Vice President, Health Care Group, Robert Wood Johnson
Foundation, Princeton, NJ
JOSEPH R. BETANCOURT, M.D., M.P.H., Senior Scientist,
Institute for Health Policy, Director for Multicultural Education,
Multicultural Affairs Office, Massachusetts General Hospital,
Partners HealthCare System, Boston, MA
M. GREGG BLOCHE, J.D., M.D., Professor of Law, Georgetown
University and Co-Director, Georgetown-Johns Hopkins Joint
Program in Law and Public Health, Washington, DC
W. MICHAEL BYRD, M.D., M.P.H., Instructor and Senior Research
Scientist, Harvard School of Public Health, and Instructor/Staff
Physician, Beth Israel Deaconess Hospital, Boston, MA
JOHN F. DOVIDIO, Ph.D., Charles A. Dana Professor of
Psychology and Interim Provost and Dean of Faculty, Colgate
University, Hamilton, NY
JOSE ESCARCE, M.D., Ph.D., Senior Natural Scientist, RAND
and Adjunct Professor, UCLA School of Public Health, Los
Angeles, CA
SANDRA ADAMSON FRYHOFER, M.D., M.A.C.P., practicing
internist and Clinical Associate Professor of Medicine, Emory
University School of Medicine, Atlanta, GA
THOMAS INUI, Sc.M., M.D., Senior Scholar, Fetzer Institute,
Kalamazoo and Petersdorf Scholar-in-Residence, Association of
American Medical Colleges, Washington, DC
JENNIE R. JOE, Ph.D., M.P.H., Professor of Family and Community
Medicine, and Director of the Native American Research and
Training Center, University of Arizona, Tucson, AZ
THOMAS McGUIRE, Ph.D., Professor of Health Economics,
Department of Health Care Policy, Harvard Medical School,
Boston, MA
Copyright © National Academy of Sciences. All rights reserved.
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
http://www.nap.edu/catalog/10260.html
CAROLINA REYES, M.D., Vice President, Planning and
Evaluation, The California Endowment, Woodland Hills, CA,
and Associate Clinical Professor, UCLA School of Medicine, Los
Angeles, CA
DONALD STEINWACHS, Ph.D., Chair and Professor of the
Department of Health Policy and Management, Johns Hopkins
School of Hygiene and Public Health, and Director, Johns
Hopkins University Health Services Research and Development
Center, Baltimore, MD
DAVID R. WILLIAMS, Ph.D., M.P.H., Professor of Sociology and
Research Scientist, Institute for Social Research, University of
Michigan, Ann Arbor, MI
HEALTH SCIENCES POLICY BOARD LIAISON
GLORIA E. SARTO, M.D., Ph.D., Professor, University of Wisconsin
Health, Department of Obstetrics and Gynecology, Madison, WI
IOM PROJECT STAFF
BRIAN D. SMEDLEY, Study Director
ADRIENNE Y. STITH, Program Officer
DANIEL J. WOOTEN, Scholar-in-Residence
THELMA L. COX, Senior Project Assistant
SYLVIA I. SALAZAR, Edward Roybal Public Health Fellow,
Congressional Hispanic Caucus Institute
IOM STAFF
ANDREW M. POPE, Director, Board on Health Sciences Policy
ALDEN CHANG, Administrative Assistant
CARLOS GABRIEL, Financial Associate
PAIGE BALDWIN, Managing Editor
COPY EDITOR
JILL SHUMAN
vi
Copyright © National Academy of Sciences. All rights reserved.
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
http://www.nap.edu/catalog/10260.html
REVIEWERS
This report has been reviewed in draft form by individuals chosen for their di-
verse perspectives and technical expertise, in accordance with procedures ap-
proved by the NRC’s Report Review Committee. The purpose of this indepen-
dent review is to provide candid and critical comments that will assist the
institution in making its published report as sound as possible and to ensure that
the report meets institutional standards for objectivity, evidence, and responsive-
ness to the study charge. The review comments and draft manuscript remain
confidential to protect the integrity of the deliberative process. We wish to thank
the following individuals for their review of this report:
LU ANN ADAY, Professor of Behavioral Sciences, University of Texas-Houston
Science Center, TX
JOHN F. ALDERETE, Professor of Microbiology, University of Texas Health
Science Center at San Antonio, TX
NAIHUA DUAN, Professor-in-Residence, Center for Community Health, UCLA
Wilshire Center, Los Angeles, CA
DEAN M. HASHIMOTO, Associate Professor, Boston College Law School,
Newton, MA
SHERMAN A. JAMES, Director, Center for Research on Ethnicity Culture &
Health, School of Public Health, University of Michigan, Ann Arbor, MI
JEROME P. KASSIRER, Yale University School of Medicine, New Haven,
CT
WOODROW A. MYERS, Executive Vice President, Wellpoint Health Net-
works, Thousand Oaks, CA
FRANK A. SLOAN, Director, Center for Health Policy, Law & Management,
Duke University, Durham, NC
KNOX H. TODD, Adjunct Associate Professor, The Rollins School of Public
Health, Emory University School of Medicine, Atlanta, GA
WILLIAM A. VEGA, Director, Behavioral and Research Training Institute,
Universit of Medicine and Dentistry of New Jersey, New Brunswick, NJ
EUGENE WASHINGTON, Professor and Chair, Department of Ob/Gyn &
Reproductive Sciences, University of California, San Francisco, CA
Although the reviewers listed above have provided many constructive comments
and suggestions, they were not asked to endorse the conclusions or recommenda-
tions nor did they see the final draft of the report before its release. The review of
this report was overseen by HAROLD C. SOX, Editor, Annals of Internal Medicine,
Philadelphia, PA, appointed by the Institute of Medicine, and ELAINE L.
LARSON, Professor of Pharmaceutical & Therapeutic Research, Columbia Uni-
versity School of Nursing, New York, NY. Appointed by the NRC’s Report Re-
view Committee, these individuals were responsible for making certain that an
independent examination of this report was carried out in accordance with insti-
tutional procedures and that all review comments were carefully considered.
Responsibility for the final content of this report rests entirely with the authoring
committee and the institution.
vii
Copyright © National Academy of Sciences. All rights reserved.
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
http://www.nap.edu/catalog/10260.html
Copyright © National Academy of Sciences. All rights reserved.
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
http://www.nap.edu/catalog/10260.html
Acknowledgments
Many individuals and groups made important contributions to the
study committee’s process and to this report. The committee wishes to
thank all of these individuals and organizations, but recognizes that at-
tempts to identify all and acknowledge their contributions would require
more space than is available in this brief section.
To begin, the committee would like to thank the sponsors of this
report. Core funds for the committee’s work were provided by the Office
of Minority Health, U.S. Department of Health and Human Services, in
response to a Congressional request. The committee thanks Joan Jacobs
and Olivia Carter-Pokras of this office, who served as the Task Order
Officers on this grant. Additional funding for data collection efforts was
provided by the Henry J. Kaiser Family Foundation of Menlo Park, Cali-
fornia, and The Commonwealth Fund, a New York City-based private,
independent foundation. The committee thanks Marsha Lillie-Blanton of
the Henry J. Kaiser Family Foundation, and Karen Scott Collins and Dora
L. Hughes of The Commonwealth Fund for their support.
The committee found the perspectives of many individuals and or-
ganizations to be valuable in understanding the complex problem of
racial and ethnic disparities in healthcare. Several individuals and orga-
nizations provided important information at open workshops of the
committee. These include, in order of appearance, Nathan Stinson,
Ph.D., M.D., M.P.H., Deputy Assistant Secretary for Minority Health,
U.S. Department of Health and Human Services; Charles Dujon, Legis-
lative Assistant, Office of the Honorable Jessie Jackson, Jr., U.S. House
ix
Copyright © National Academy of Sciences. All rights reserved.
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
http://www.nap.edu/catalog/10260.html
x ACKNOWLEDGMENTS
of Representatives; Rodney Hood, M.D., National Medical Association;
Adolph Falcon, M.P.P., National Alliance for Hispanic Health; Jeanette
Noltenius, Ph.D., Latino Council on Alcohol and Tobacco, representing
the Multicultural Action Agenda for Eliminating Health Disparities; Yvonne
Bushyhead, J.D., and Beverly Little Thunder, R.N., National Indian Health
Board; H. Jack Geiger, M.D., City University of New York; Deborah Danoff,
M.D., Assistant Vice President, Division of Medical Education, American
Association of Medical Colleges; Paul M. Schyve, M.D., Senior Vice Presi-
dent, Joint Commission on Accreditation of Healthcare Organizations;
Sindhu Srinivas, M.D., President, American Medical Student Association;
Mary E. Foley, R.N., MS, President, American Nurses Association;
Randolph D. Smoak, Jr., M.D., President, American Medical Association;
Terri Dickerson, Assistant Staff Director, U.S. Commission on Civil Rights;
Carolyn Clancy, M.D., Agency for Health Care Research and Quality;
James Youker, M.D., President, American Board of Medical Specialties;
Ray Werntz, Consumer Health Education Council; Vickie Mays, Ph.D.,
Chair, National Committee on Vital and Health Statistics Subcommittee
on Populations; Robyn Nishimi, Ph.D., Chief Operating Officer, National
Quality Forum; Lovell Jones, Ph.D., Intercultural Cancer Council; David
Satcher, M.D., Ph.D., U.S. Surgeon General; Richard Epstein, J.D., James
Parker Hall Distinguished Service Professor of Law, University of Chicago
Law School; Clark C. Havighurst, J.D., Wm. Neal Reynolds Professor of
Law, Duke University School of Law; Marsha Lillie-Blanton, Dr. P.H.,
Vice President in Health Policy, The Henry J. Kaiser Family Foundation;
June O’Neill, Ph.D., Director, Center for the Study of Business and Gov-
ernment, Baruch College of Public Affairs; Thomas Perez, J.D., M.P.P.,
Assistant Professor and Director of Clinical Law Programs, University of
Maryland Law School; and Thomas Rice, Ph.D., Professor and Vice-Chair,
Department of Health Services, UCLA School of Public Health.
The committee also gratefully acknowledges the contributions of the
many individuals who participated as members of one of four liaison
panels, which were assembled to serve as a resource to the committee, to
provide advice and guidance in identifying key information sources, to
provide recommendations to the study committee regarding intervention
strategies, and to ensure that relevant consumer and professional per-
spectives were represented. These individuals are listed in Appendix A.
Similarly, the committee thanks the many individuals who provided in-
put to study staff during “roundtable discussions” held at the Asian and
Pacific Islander American Health Forum (APIAHF) conference on April
27 and 28, 2001, and the Indian Health Service (IHS) Research Conference
on April 22 and 23, 2001. The committee extends its gratitude to Gem
Daus of APIAHF and Leo Nolan, William Freeman, and Cecelia Shorty of
IHS for their assistance in arranging these roundtable discussions.
Copyright © National Academy of Sciences. All rights reserved.